An Experimental Study of Prefabricated Flaps Using Silicone Sheets, with Reference to the Vascular Patternization Process

Influence of Silicone Sheets on Microvascular Anastomosis

“…The procedure provides the option of creating thin, large, and suitable flaps with minimal morbidity regardless of natural vascular anatomy. This type of flap has been experimentally investigated [5,8,10,11,15,19,21,23,27,28]. The most important requirement for determining successful transfer of prefabricated flaps is maturation of neovascularization.…”

“…Experimental investigations indicated increasing blood flow in the implanted vascular pedicle combined with silicone sheet implantation played important roles [10,11,15,21]. Using a silicone sheet and arteriovenous pedicle with microanastomosis, numerous authors have reported 20 days is the minimal time required for neovascularization maturation [10,11,16,15,27,28].…”

“…Silicone implants are widely used for breast augmentation [3,7,9,29,31], restoration of contour deficiencies [18], scar management [20], and intensifying neovascularization in prefabricated flaps [15,21,28]. They also have been used experimentally and clinically in association with free vascularized flaps to reconstruct tissue defects in the ear and nose [4,12,16], and the trachea [6].…”

Proposed new method for angiographically quantifying neovascularization in prefabricated flaps

“…This technique provides the option of creating thin, large, and suitable well-perfused flaps with minimal morbidity, which can fulfill the specific requirements of defect reconstruction regardless of natural vascular anatomy. 7,10,14 The most important requirement for determining successful free transfer of prefabricated flaps from the prefabrication area to the recipient area is the maturation of neovascularization in prefabricated flaps, i.e., the entire flap is independently well-perfused by the blood flow supplied from the newly implanted pedicle. Neovascularization in prefabricated flaps is considered mature when the newly vascularized system is identical in number and form to the original physiological flap perfusion.…”

“…Based on this principle, the quantification of neovascularization in any size of prefabricated flap can be easily performed using suitably 1À19 Based on the neovascularization process which spontaneously occurs between a newly implanted vascular pedicle and the random-pattern vascularized system in the flap, an axially neovascularized flap is created which can be freely transferred using microsurgical techniques. 2,6,8,10 The most important advantages of prefabricated flaps are that they allow versatility in flap choice and permit the production of specific axially vascularized tissue materials required in clinical practice, regardless of the natural anatomical vascular territories. 7,16 In order to successfully transfer prefabricated flaps from the prefabrication area to the recipient area using microsurgery, there is unanimous agreement among reconstructive surgeons that the development of neovascularization in the flap must have already reached maturity.…”